Radikale Chirurgie bei primär metastasierten kolorektalen Karzinomen

Weber, Thomas; Link, K. H.

doi:10.1159/000110482

Cited by 3 publications

(2 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Abb. 4 Multimodale Konzepte in der Behandlung von primär metastasierten Kolon-und Rektumkarzinomen (UICC Stadium IV) (nach [11]).…”

Section: Resektable Lebermetatsasenunclassified

Kolonkarzinom: Aktueller Stand der multimodalen Therapie

Weber

K²

2011

Zentralbl Chir

View full text Add to dashboard Cite

In UICC stage I a selected group of patients with T1 tumours and a low risk profile regarding simultaneous lymph node metastases can be treated by endoscopic resection alone, if the tumour is thereby completely removed. In UICC stage II an adjuvant chemotherapy (CT) should not be routinely performed. However, in high risk UICC stage II patients (T4 tumour, less than 12 examined lymph nodes, emergency surgery, intraoperative tumour perforation), an adjuvant CT with infusional 5-FU/FA should be recommended. The state of the art in UICC stage III is an adjuvant CT with FOLFOX. In this tumour stage no beneficial effect of CT involving irinotecan or monoclonal antibodies has been documented. Due to CT-induced side effects an infusional 5-FU/FA protocol or oral capecitabine should be given in patients older than 70 years. In stage UICC IV with resectable liver metastases, surgical resection of the primary tumour and the metastases should be implemented. Since no conclusive data are currently available regarding the beneficial effect of neoadjuvant, perioperative or adjuvant CT in this setting, the therapeutic strategy should be individually discussed between surgeons and oncologists (tumour board). In cases of non-resectable liver metastases a neoadjuvant CT should be performed, preferentially with a FOLFOX protocol in combination with targeted therapies, i.e., the monoclonal antibody cetuximab, aimed at tumour regression with radical metastasectomy as the secondary intent (R0). Patients with UICC stage II colon cancer and microsatellite instability (MSI) apparently experience a better prognosis but do not profit from an adjuvant CT with 5-FU/FA alone. If a CT is under consideration for these patients, the MSI status should be determined on tumour tissue. In cases of a positive result a combination CT, i.e., with FOLFOX, should be given. The relevance of the MSI status in other tumour stages is as yet unknown. Before targeted therapies, i.e., cetuximab or panitumumab, are initiated, the KRAS status needs to be determined, since therapies with antibodies against the epithelial growth factor receptor (EGFR) are only effective in tumours bearing the KRAS wild-type.

show abstract

“…Abb. 4 Multimodale Konzepte in der Behandlung von primär metastasierten Kolon-und Rektumkarzinomen (UICC Stadium IV) (nach [11]).…”

Section: Resektable Lebermetatsasenunclassified

Kolonkarzinom: Aktueller Stand der multimodalen Therapie

Weber

K²

2011

Zentralbl Chir

View full text Add to dashboard Cite

show abstract

“…Unfortunately, only 10–15% of patients diagnosed with colorectal liver metastases are candidates for curative resection [ 2 ] . In cases of non-resectable liver metastasis with potential resectability after down-staging, intensive systemic chemotherapy should be applied to reach the aim of secondary resectability [ 3 ] . Nowadays, chemotherapy regimens such as combined use of folinic acid and oxaliplatin (folinic acid, fluorouracil, oxaliplatin; FOLFOX) or irinotecan (folinic acid, fluorouracil, irinotecan; FOLFIRI) are the recommended and prevailing protocols [ 4 ] .…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant treatment of colorectal liver metastases is associated with altered contrast enhancement on computed tomography

Bethke¹,

Kühne²,

Platzek³

et al. 2011

Cancer Imaging

View full text Add to dashboard Cite

Neoadjuvant systemic therapy may induce steatosis or sinusoid obstruction syndrome in the liver. The aim of this study was to investigate the influence of systemic therapy with irinotecan, oxaliplatin and cetuximab on conspicuity of liver metastases on computed tomography (CT). CT scans of 48 patients with initial unresectable colorectal liver metastases which were treated in a Europe-wide, opened, randomized phase II trial receiving oxaliplatin or irinotecan combined with folinic acid and cetuximab were analysed. The density of the metastases and the liver parenchyma before and after systemic therapy were analysed by region-of-interest technique and the tumour-to-liver difference (dHU TLD). The mean density of liver parenchyma and liver metastases did not vary significantly before and after neoadjuvant therapy on plain (56.3 ± 8.1 HU, 54.8 ± 13.5 HU) and arterial enhanced CT (76.0 ± 15.7 HU, 70.5 ± 20.4 HU). There was a significant reduction (105.6 ± 17.3 HU, 93.3 ± 18.2 HU) in the density of liver parenchyma on portal venous scans after systemic therapy (p < 0.0001) and a reduction of dHU TLD, consecutively. In patients with colorectal liver metastases, neoadjuvant chemotherapy may have a toxic impact on liver parenchyma resulting in reduced tumour-to-liver contrast in contrast-enhanced CT. This may lead to underestimation of real lesion size.

show abstract